title: A study to evaluate the acceptability, feasibility and impact of packaged interventions ("Diarrhea Pack") for prevention and treatment of childhood diarrhea in rural Pakistan.
abstract: BACKGROUND
  Diarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age. Interventions such as ORS, Zinc, water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before. This study attempts to evaluate the package of evidence based interventions in a "Diarrhea Pack" through first level health care providers at domiciliary level in community based settings. This study sought to evaluate the acceptability, feasibility and impact of diarrhea Pack on diarrhea burden.
  
  
  METHODS
  A cluster randomized design was used to evaluate the objectives of the project a union council was considered as a cluster for analysis, a total of eight clusters, four in intervention and four in control were included in the study. We conducted a baseline survey in all clusters followed by the delivery of diarrhea Pack in intervention clusters through community health workers at domiciliary level and through sales promoters to health care providers and pharmacies. Four quarterly surveillance rounds were conducted to evaluate the impact of diarrhea pack in all clusters by an independent team of Field workers.
  
  
  RESULTS
  Both the intervention and control clusters were similar at the baseline but as the study progress we found a significant increase in uptake of ORS and Zinc along with the reduction in antibiotic use, diarrhea burden and hospitalization in intervention clusters when compared with the control clusters. We found that the Diarrhea Pack was well accepted with all of its components in the community.
  
  
  CONCLUSIONS
  The intervention was well accepted and had a productive impact on the uptake of ORS and zinc and reduction in the use of antibiotics. It is feasible to deliver interventions such as diarrhea pack through community health workers in community settings. The intervention has the potential to be scaled up at national level.
authors.affiliation: Department of Paediatrics and Child Health, Women and Child Health Division, Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edu.
authors.forename: Muhammad Atif
authors.initials: MA
authors.lastname: Habib
authors.forename: Sajid
authors.initials: S
authors.lastname: Soofi
authors.forename: Kamran
authors.initials: K
authors.lastname: Sadiq
authors.forename: Tariq
authors.initials: T
authors.lastname: Samejo
authors.forename: Musawar
authors.initials: M
authors.lastname: Hussain
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Mirani
authors.forename: Asmatullah
authors.initials: A
authors.lastname: Rehmatullah
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmed
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D003258:Consumer Behavior; D003967:Diarrhea / Q000517:prevention & control / Q000628:therapy*; D004864:Equipment and Supplies; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D010154:Pakistan; D011247:Pregnancy; D012423:Rural Health; D012499:Sanitation / Q000295:instrumentation; D014871:Water Microbiology